脓毒症致急性肾损伤与微循环障碍的关系研究
Relationship between Acute Renal Injury In-duced by Sepsis and Microcirculation Disturbance
摘要: 急性肾损伤发生最常见的原因是脓毒症,脓毒症导致肾脏微循环的改变是脓毒症相关急性肾损伤的主要原因,脓毒症通过炎症反应、球管失衡和血流重分布来影响肾脏微循环,进而导致肾小管坏死,针对病因出现了抗炎、液体复苏和血流重分布的治疗措施。本文旨在研究SA-AKI发生的机制,从而预防脓毒症患者进一步损伤肾脏及减低脓毒症患者死亡率,现就近年研究进展做一综述。
Abstract: Sepsis is the most common cause of acute kidney injury, and the change of renal microcirculation caused by sepsis is the main cause of sepsis-associated acute kidney injury, sepsis affects renal mi-crocirculation through inflammatory reaction, imbalance of bulbar duct and redistribution of blood flow, which leads to tubular necrosis. Anti-inflammatory, fluid resuscitation and redistribution of blood flow have been suggested to treat sepsis. This article aims to study the mechanism of SA-AKI, so as to prevent further renal damage and reduce mortality in patients with sepsis.
文章引用:胡洁, 罗朋立. 脓毒症致急性肾损伤与微循环障碍的关系研究[J]. 临床医学进展, 2023, 13(10): 15308-15313. https://doi.org/10.12677/ACM.2023.13102142

参考文献

[1] 张莎, 陈刘, 孙曹周. 基于社区老年健康体检人群的慢性肾脏病流行病学调查[J]. 实用医学杂志, 2021, 37(13): 1755-1760.
[2] Singer, M., Deutschman, C.S., Seymour, C.W., et al. (2016) The Third International Consensus Defi-nitions for Sepsis and Septic Shock (Sepsis-3). JAMA, 315, 801-810. [Google Scholar] [CrossRef] [PubMed]
[3] Peerapornratana, S., Manrique-Caballero, C.L., Gómez, H. and Kellum, J.A. (2019) Acute Kidney Injury from Sepsis: Current Concepts, Epidemiology, Pathophysiology, Prevention and Treatment. Kidney International, 96, 1083-1099. [Google Scholar] [CrossRef] [PubMed]
[4] Manrique-Caballero, C.L., Del Rio-Pertuz, G. and Gomez, H. (2021) Sepsis-Associated Acute Kidney Injury. Critical Care Clinics, 37, 279-301. [Google Scholar] [CrossRef] [PubMed]
[5] Jansen, M.P.B., Pulskens, W.P., Butter, L.M., et al. (2018) Mito-chondrial DNA is Released in Urine of SIRS Patients with Acute Kidney Injury and Correlates with Severity of Renal Dysfunction. Shock, 49, 301-310. [Google Scholar] [CrossRef
[6] Beunders, R., Schutz, M.J., Van Groenendael, R., et al. (2020) Endotoxemia-Induced Release of Pro-Inflammatory Mediators Are Associated with Increased Glomerular Filtra-tion Rate in Humans in Vivo. Frontiers in Medicine, 7, Article 559671. [Google Scholar] [CrossRef] [PubMed]
[7] Dellepiane, S., Marengo, M. and Cantaluppi, V. (2016) Detrimental Cross-Talk between Sepsis and Acute Kidney Injury: New Pathogenic Mechanisms, Early Biomarkers and Targeted Therapies. Critical Care, 20, Article No. 61. [Google Scholar] [CrossRef] [PubMed]
[8] Nakano, D. (2020) Septic Acute Kidney Injury: A Review of Basic Research. Clinical and Experimental Nephrology, 24, 1091-1102. [Google Scholar] [CrossRef] [PubMed]
[9] Ergin, B., Kapucu, A., Demirci-Tansel, C. and Ince, C. (2015) The Renal Microcirculation in Sepsis. Nephrology Dialysis Transplantation, 30, 169-177. [Google Scholar] [CrossRef] [PubMed]
[10] Vlahu, C.A., Lemkes, B.A., Struijk, D.G., et al. (2012) Damage of the Endothelial Glycocalyx in Dialysis Patients. Journal of the American Society of Nephrology, 23, 1900-1908. [Google Scholar] [CrossRef
[11] Gomez, H. and Kellum, J.A. (2016) Sepsis-Induced Acute Kidney Injury. Current Opinion in Critical Care, 22, 546- 553. [Google Scholar] [CrossRef
[12] Zafrani, L., Payen, D., Azoulay, E. and Ince, C. (2015) The Microcirculation of the Septic Kidney. Seminars in Nephro- logy, 35, 75-84. [Google Scholar] [CrossRef] [PubMed]
[13] Singh, A., Ramnath, R.D., Foster, R.R., et al. (2013) Reac-tive Oxygen Species Modulate the Barrier Function of the Human Glomerular Endothelial Glycocalyx. PLOS ONE, 8, e55852. [Google Scholar] [CrossRef] [PubMed]
[14] Martensson, J. and Bellomo, R. (2015) Sepsis-Induced Acute Kidney Injury. Critical Care Clinics, 31, 649-660. [Google Scholar] [CrossRef] [PubMed]
[15] Hering, D. and Winklewski, P.J. (2017) R1 Autonomic Nervous System in Acute Kidney Injury. Clinical and Experi- mental Pharmacology and Physiology, 44, 162-171. [Google Scholar] [CrossRef] [PubMed]
[16] Oliver, J., Macdowell, M. and Tracy, A. (1951) The Pathogenesis of Acute Renal Failure Associated with Traumatic and Toxic Injury. Renal Ischemia, Nephrotoxic Damage and the Ischemu-ric Episode. Journal of Clinical Investigation, 30, 1307-1439. [Google Scholar] [CrossRef
[17] Prowle, J.R. and Bellomo, R. (2015) Sepsis-Associated Acute Kidney Injury: Macrohemodynamic and Microhemo- dynamic Altera-tions in the Renal Circulation. Seminars in Nephrology, 35, 64-74. [Google Scholar] [CrossRef] [PubMed]
[18] Calzavacca, P., Evans, R.G., Bailey, M., Bellomo, R. and May, C.N. (2015) Cortical and Medullary Tissue Perfusion and Oxygenation in Experimental Septic Acute Kidney Injury. Critical Care Medicine, 43, e431-e439. [Google Scholar] [CrossRef
[19] Calzavacca, P., Evans, R.G., Bailey, M., et al. (2015) Long-Term Measurement of Renal Cortical and Medullary Tissue Oxygenation and Perfusion in Unanesthetized Sheep. American Journal of Physiology-Regulatory, Integrative and Com- parative Physiology, 308, R832-R839. [Google Scholar] [CrossRef] [PubMed]
[20] Fry, B.C., Edwards, A., Sgouralis, I. and Layton, A.T. (2014) Impact of Renal Medullary Three-Dimensional Architecture on Oxygen Transport. American Journal of Physiolo-gy-Renal Physiology, 307, F263-F272. [Google Scholar] [CrossRef] [PubMed]
[21] Post, E.H., Kellum, J.A., Bellomo, R. and Vincent, J.-L. (2017) Renal Perfusion in Sepsis: From Macro- to Microcir- culation. Kidney International, 91, 45-60. [Google Scholar] [CrossRef] [PubMed]
[22] Langenberg, C., Gobe, G., Hood, S., May, C.N. and Bellomo, R. (2014) Renal Histopathology during Experimental Septic Acute Kidney Injury and Recovery. Critical Care Medicine, 42, e58-e67. [Google Scholar] [CrossRef
[23] Bagshaw, S.M., Lapinsky, S., Dial, S., et al. (2009) Acute Kidney Injury in Septic Shock: Clinical Outcomes and Impact of Duration of Hypotension Prior to Initiation of Antimi-crobial Therapy. Intensive Care Medicine, 35, 871-881. [Google Scholar] [CrossRef] [PubMed]
[24] 黄浩, 汪薇, 柳林伟. 不同标准对脓毒症急性肾损伤患者预后评估的价值[J]. 中华实验和临床感染病杂志(电子版), 2016, 10(4): 435-439.
[25] Cantaluppi, V., Assenzio, B., Pasero, D., et al. (2008) Polymyxin-B Hemoperfusion Inactivates Circulating Proapoptotic Factors. Intensive Care Medi-cine, 34, 1638-1645. [Google Scholar] [CrossRef] [PubMed]
[26] Vincent, J.-L. and Gerlach, H. (2004) Fluid Resuscitation in Severe Sepsis and Septic Shock: An Evidence-Based Review. Critical Care Medicine, 32, S451-S454. [Google Scholar] [CrossRef
[27] Kwon, O., Nelson, W.J., Sibley, R., Huie, P., Scan-dling, J.D., Dafoe, D., Alfrey, E. and Myers, B.D. (1998) Backleak, Tight Junctions, and Cell-Cell Adhesion in Postis-chemic Injury to the Renal Allograft. Journal of Clinical Investigation, 101, 2054-2064. [Google Scholar] [CrossRef
[28] Wang, N., Jiang, L., Zhu, B., et al. (2015) Fluid Balance and Mortality in Crit-ically Ill Patients with Acute Kidney Injury: A Multicenter Prospective Epidemiological Study. Critical Care, 19, Article No. 371. [Google Scholar] [CrossRef] [PubMed]
[29] Rhodes, A., Evans, L.E., Alhazzani, W., et al. (2017) Surviving Sepsis Campaign: International Guidelines for Manage- ment of Sepsis and Septic Shock: 2016. Intensive Care Medicine, 43, 304-377. [Google Scholar] [CrossRef] [PubMed]
[30] Barbar, S.D., Clere-Jehl, R., Bourredjem, A., et al. (2018) Timing of Renal-Replacement Therapy in Patients with Acute Kidney Injury and Sepsis. New England Journal of Medicine, 379, 1431-1442. [Google Scholar] [CrossRef
[31] Ankawi, G., Neri, M., Zhang, J., et al. (2018) Extracorporeal Techniques for the Treatment of Critically Ill Patients with Sepsis Beyond Conventional Blood Purification Therapy: The Promises and the Pitfalls. Critical Care, 22, Article No. 262. [Google Scholar] [CrossRef] [PubMed]
[32] Park, J.T., Lee, H., Kee, Y.K., et al. (2016) High-Dose versus Conventional-Dose Continuous Venovenous Hemodiafiltration and Patient and Kidney Survival and Cytokine Removal in Sepsis-Associated Acute Kidney Injury: A Randomized Con-trolled Trial. American Journal of Kidney Diseases, 68, 599-608. [Google Scholar] [CrossRef] [PubMed]